Remote Nurse RN: Care Coordination & Outcomes

NurseRemotely; United States; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health benefits

Referral program

Excellent growth opportunities

Job summary

NurseRemotely seeks a licensed RN for a remote role serving as a care coordinator for health insurance members. You will design and adjust care plans, assess health risks, and collaborate with interdisciplinary teams to ensure quality, efficient care paths across plan types.

Responsibilities include referrals to QM/DM etc., care reviews, and adjusting plans to meet clinical guidelines while supporting member engagement and outcomes in a national remote setting.

Qualifications

• RN required and licensed to practice.
• At least 2 years of Agile experience.
• Managed Care experience, specifically DSNP.
• Proficient with Microsoft applications.
• Excellent organization and thorough documentation.

Responsibilities

• Research and design treatment/care plans to promote quality of care and cost-effective services per contract.
• Initiate timely individualized care plans based on health risk assessments and interdisciplinary meetings.
• Determine appropriateness of referrals for CM, mental health, and social services.
• Provide referrals to QM, DM and Appeals/Grievance departments.
• Conduct member care reviews with medical groups for continuity of care and network considerations.
• Manage member treatment to meet recommended length of stay and plan at appropriate care levels.
• Assess health behaviors and cultural factors, evaluating plans against guidelines.
• Promote continuous improvement and identify barriers to success for members and providers.
• Set realistic goals, engage clients, and offer appropriate alternatives.
• Develop fiscally responsible care plans with targeted interventions to improve outcomes.
• Reassess and modify plans as healthcare needs evolve over time.

Skills

Agile experience

DSNP

Microsoft applications

Organization & documentation

Education

RN

Job description

NurseRemotely seeks a licensed RN for a remote role serving as a care coordinator for health insurance members. You will design and adjust care plans, assess health risks, and collaborate with interdisciplinary teams to ensure quality, efficient care paths across plan types.

Responsibilities include referrals to QM/DM etc., care reviews, and adjusting plans to meet clinical guidelines while supporting member engagement and outcomes in a national remote setting.